Consultant Psychiatrist


El C


Despite the revolutionary benefit of topical steroids in the treatment of atopic eczema, they are often feared, and may be avoided or used only cautiously. They seem to be seen more as terrorists than freedom fighters.

Understanding how they work, and how to use them, enables their safe use without risk of side effects.

Topical steroids are graded in four potencies, from IV: the weakest, to I: the strongest. The natural sensitivity of skin to topical steroids varies with the part of the body being treated. While the strongest steroids are sometimes required for the hands, feet and scalp, the weakest may be appropriate for the face and genital area. Other parts are intermediate in sensitivity, though care should be taken with the thin skin on the inside of the thighs and upper arms.

In disease, lichenification can make otherwise sensitive skin relatively resistant to topical steroids. Then even on the face the strongest steroids may be required, under close supervision and as part of a planned treatment programme.

Apart from different strengths, some areas such as the the scalp, and ears may pose practical problems. Particular preparations are however available on prescription.



Dr Christopher Bridgett (DrB) is a specialist in Adult General Psychiatry who has also worked in Dermatology since being first introduced to Psychodermatology by Arthur Rook in 1971. Together with dermatologists Richard Staughton (London) and Peter Norén (Uppsala) he co-authored Atopic Skin Disease - A Manual for Practitioners, which sets out a behavioural approach for the successful management of atopic eczema. Now retired from both NHS and private practice, he continues to teach and advise at Chelsea & Westminster Hospital, London and runs an online community for both practitioners and patients interested in The Combined Approach to the treatment of atopic eczema:

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